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Biomedical subjects

F Varoli

Publications and source records attributed to F Varoli.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Preoperative role of computerized tomography in videothoracoscopic lung surgery].

Video-assisted thoracic surgery (VATS) is used in a growing range of pulmonary and mediastinal conditions. By avoiding thoracotomy, VATS is minimally invasive and allows shorter postoperative hospitalization. The advantages of video-assisted thoracoscopic techniques are obvious in the patients with severe cardiorespiratory failure. We investigated the role of CT before VATS. From September, 1991, to January, 1994, two hundred and eight patients were submitted to VATS: 80 pleurectomies, 63 lobectomies, 42 wedge resections, 11 bullectomies, 8 biopsies and 4 pneumonectomies were performed in patients with diffuse lung disease. All patients underwent conventional CT and an additional HRCT was performed in 164 patients. Bullae site, number, characteristics and size must be assessed. The possible relationship of bullae to impaired respiratory function must be studied. When nodules are present, their site, depth and relationship to fissures must be defined. With small and deep-seated nodules a thin snap-open mandrel device should be used for intraoperative detection. When lobectomies are contemplated, fissures must be accurately studied to assess their integrity and whether they completely separate the lobes. Fibrous adhesions can prevent pulmonary collapse; unfortunately, some of them cannot be detected by CT. Another limitation is the difficulty in assessing whether fissures are incomplete. To conclude, CT integrated with HRCT provides useful information for correct video-assisted thoracic surgical management.

Adult↗
PubMed1994

Videothoracoscopic excision of mediastinal masses: indications and technique.

Mediastinal masses are generally excised through wide thoracotomies or median sternotomies. These lesions are often benign, usually asymptomatic, discovered incidentally, and relatively easy to resect. For these reasons, a minimally invasive approach is appropriate. Videothoracoscopy allows an optimal exploration of the pleural cavity and a panoramic view of the mass. Dissection is usually easy to perform, and the mass can be extracted from the thorax through a trocar incision or through a limited "utility thoracotomy." To avoid possible tumor seeding, the mass is inserted in a plastic bag before extraction. From September 1991 to January 30, 1994, 20 mediastinal masses (6 thymomas, 2 thymic cysts, 1 hyperplastic thymus, 1 fibrous tumor of the mediastinum, 2 pleuropericardial cysts, 2 thoracic teratomas, 2 large thoracic lipomas, 3 neurogenic tumors, and 1 bronchogenic cyst) were removed through such a minimally invasive approach. Eighteen patients had an uneventful postoperative course. Two patients hemorrhaged in the immediate postoperative period, and repeat thoracoscopy was done. In 1 patient, electrocoagulation of a bleeding intercostal artery controlled the hemorrhage. In the other, the source of bleeding could not be found, and removal of the clots and irrigation of the cavity stopped the hemorrhage. Further data and long-term follow-up are necessary, but videothoracoscopy offers a new, less invasive approach for the management of noninvasive mediastinal masses.

Adult↗
PubMed1994

Tracheal sleeve pneumonectomy for bronchogenic carcinoma.

For a long time, primary tumors arising less than 2 cm distal to the carina have presented a contraindication to surgical excision. Tracheal sleeve pneumonectomy technique allows carinal resection and reconstruction but still carries considerable postoperative complications. From 1983 to 1992 we performed 27 right tracheal sleeve pneumonectomies and one left. Fourteen patients had N0 nodes, nine had N1, and five had N2. No anastomotic complications, either fistula or stenosis, were observed. Successful outcome depends on meticulous attention to surgical details and careful anaesthetic management with a new ventilation tube. One patient died on the twenty-second postoperative day from myocardial infarction. Complications included pneumonia (one), vocal cord paresis (two), and pleural empyema without bronchial fistula (one). Conservative treatment allowed complete recovery from all complications. There are seven patients alive at 4 years after operation and one at 5 years. Six patients have been disease-free for between 1 and 32 months. Two patients died free of disease at 13 and 42 months. Two patients died of mediastinal recurrence and 10 of distant metastases within 6 and 54 months.

Adult↗
PubMed1993

Major pulmonary resections: pneumonectomies and lobectomies.

We report on our experience in 20 patients who underwent major thoracoscopic pulmonary resections between October 1991 and November 1992. These consist of 2 left pneumonectomies, 17 lobectomies, and 1 segmentectomy. The indications were strictly limited to benign pulmonary diseases and stage I (TNM) primary lung cancer. A hilar lymphadenectomy was performed in all cases of malignancy. Our surgical technique is described. Our findings demonstrate the feasibility of performing major video-assisted thoracoscopic pulmonary resections, even though the definite role of this procedure in the management of lung cancer must still be defined.

Female↗
PubMed1993

Videothoracoscopic excision of a mediastinal thymoma.

The authors have applied the advances in optics, endotelevision monitoring, and instrumentation that have led to the development of videoendoscopic abdominal surgery to performing major excisional procedures in the thorax. A videothoracoscopic technique for the removal of a mediastinal thymoma is described. The procedure was done on a 24-year-old woman suffering from a benign lymphoepithelial thymoma of the mediastinum. The mediastinal mass was mobilized under videolaparoscopic guidance and extracted from the thorax through a small (4 cm) inframammary incision. The postoperative course was uneventful, and the patient experienced minimal postoperative pain. She was discharged on the 3rd postoperative day with excellent functional and cosmetic results and resumed normal activity 4 days later.

Adult↗
PubMed1993

[Preoperative localization and anchoring of pulmonary nodules under computed tomography guidance].

Videoendoscopic thoracic surgery is often employed to remove peripheral lung nodules. Since manual palpation is excluded, the authors obviate the difficulty of intraoperative nodule localization by employing a thin snap open mandrel under CT to guidance localize, fix and anchor the nodule. Traction can be exerted on the device allowing for rapid nodule identification and facilitating wedge resection removal. This technical innovation, as yet applied only to a limited number of cases, widens the indications of videothoracoscopic surgery and appears complication-free.

Humans↗
PubMed1992

Videoendoscopic pulmonary lobectomy for cancer.

A videothoracoscopic right lower pulmonary lobectomy is reported. The excision was done in a 71-year-old man suffering from an adenocarcinoma of the right lower lobe, with an apparent absence of lymphnodal and systemic metastasis. The procedure has been performed using four 10-mm cannulas and a minimal inframammary thoracotomy (4 cm) by inserting a chip camera linked to the thoracoscope and connected to external monitors. The lobar hilar structures were dissected and then sutured-divided with Endo-GIA R shots. The specimen was extracted through the minimal thoracotomy. The postoperative course was uneventful with minimal postoperative pain, and the patient was discharged after complete surgical recovery with excellent functional and cosmetic results. This procedure in selected patients is a new and promising possibility in chest videoendoscopic surgery.

Adenocarcinoma↗
PubMed1990

Clinical application of a new compression anastomotic device for colorectal surgery.

Fifty-six patients underwent large bowel anastomosis by the compression anastomotic device developed by the authors from May 1986 through December 1988. Operations performed were 40 left hemicolectomies or anterior resections of the sigmoid and rectum, 7 left colon resections, 7 right hemicolectomies, and 2 total colectomies. Twenty-one anastomoses were done on the extraperitoneal rectum, in 7 cases less than 4 cm from the anal verge and in 9 cases between 4.5 and 8 cm. Five intraoperative diverting colostomies were done (9%). The rings of the device were evacuated postoperatively after a mean of 11 days with little or no discomfort. Operative mortality was 1.8% (one patient died of myocardial infarction). Anastomotic complications were one (1.8%) clinical and one (1.8%) subclinical leak. Mean postoperative hospital stay was 14 days. This initial clinical experience shows that the anastomotic device is reliable.

Adult↗
PubMed1990

Locally advanced lung cancer treatment: personal experience of 588 stage III operated on patients.

From 1967 to 1988, we operated on 1507 non-small cell lung cancer. Complete data concerning patients at stage III are available for 501 of them. In 73% of cases the histological type was epidermoid, in 22% it was adenocarcinoma and in 5% large cells anaplastic carcinoma. Explorative thoracotomy (E.T.) was performed in 45% of interventions whereas curative resections in 55%. Sixty-two percent of these patients underwent pneumonectomy and thirty-eight percent lobectomy. Exeresis interventions were performed in patients at stage III A in 86% of cases, whereas in patients at stage III B in 14% of cases. Five years survival rate for stage III non small cell lung cancer is 17% whereas in stage II is 33% and in stage I is 52%. The only valuable prognostic factor seems to be the size of parenchymal exeresis. Indeed, survival rate after lobectomy is 24% versus 13% after pneumonectomy. In our experience the different survival between tumours at stage III A and tumours at stage III B are not significant, when the unexpected intraoperative finding of marginal infiltration of mediastinal organ is still compatible with resection. Also the survival rates between the two histological types are not statistically significant.

Carcinoma, Non-Small-Cell Lung↗
PubMed1989

[Clinical significance of cell kinetics in lung cancer].

A series of 24 lung cancer cases was studied: 12 epidermoid carcinomas, 9 adenocarcinomas, 2 giant-cell carcinomas and 1 carcinoid. The patients were staged on the basis of the TNM classification system as 9 stage I, 5 stage II, 9 stage III and 1 stage IV. Using fresh tumour cell samples 2 cell cultures were prepared for each patient: one to identify the percentage of S phase cells (Labelling Index) using the tritiated thymidine method and one for cytogenetic analysis. A gentic map was obtained in 6 cases and revealed no specific numerical or structural alterations. The Labelling Index (L.I.) was calculated for all patients and compared with all TNM parameters. This revealed a certain connection between L.I. and parameters T, SN and G but no link with parameters.

Adenocarcinoma↗